High intake of sugar-sweetened beverages is associated with increased risk of hepatocellular carcinoma

1. Increased intake of sugar-sweetened beverages was associated with increased risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma, while intake of artificially sweetened beverages was not associated with liver cancer risk overall or by subtype. 

Evidence Rating Level: 2 (Good)

Study Rundown: Liver cancer is among the leading causes of cancer mortality worldwide. Consumption of artificially sweetened beverages (ASBs) and sugar-sweetened beverages (SSBs) has been associated with metabolic disorders such as obesity and type 2 diabetes, which are established risk factors for liver cancer. However, research on the association between beverage consumption and liver cancer subtypes remains limited and inconsistent. This study thus investigated the associations between ASB and SSB consumption and risk of incident liver cancer overall and by subtype. This was a pooled analysis of 11 prospective cohort studies from the US and Europe that included adults without a history of cancer at baseline. The exposures were self-reported intake of ASB and SSB assessed at baseline. The main outcomes were incident liver cancer overall and by subtype (hepatocellular carcinoma [HCC] and intrahepatic cholangiocarcinoma [ICC]). In total, 1,518,411 participants were analyzed. ASB intake per 1-beverage/day increase was not associated with total liver cancer risk, HCC, or ICC. SSB intake per 1-beverage/day increase was not associated with total liver cancer risk but was associated with a 10% increased risk of HCC and 15% increased risk of ICC. Overall, this study found that increased SSB intake was associated with increased risk of HCC and ICC, while ASB intake was not associated with liver cancer risk overall or by subtype. 

Click to read the study in JAMA Network Open Medicine 

Relevant reading: Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort

In-Depth [Prospective cohort study]:

This pooled analysis of 11 prospective cohort studies (10 US and 1 European) included adults without a history of cancer at baseline. Across cohorts, participants were enrolled between 1980 and 2009 and followed up through end-of-study dates ranging from 2000 to 2019. The exposures were self-reported intake of ASB and SSB assessed at baseline using food frequency questionnaires. Participants were followed up via state cancer registries or follow-up surveys for incident liver cancer. The main outcomes were incident liver cancer overall and by subtype (HCC and ICC) identified through cancer registries or medical record review. In total, 1,518,411 participants (mean [SD] age, 57.8 [10.1] years; 883,832 female [58.2%]) were analyzed, and 2,811 incident liver cancer cases were reported (1,699 HCC and 444 ICC cases) during a median (IQR) of 17.8 (12.8–23.5) years of follow-up. After adjusting for confounders, ASB intake per 1-beverage/day increase was not associated with total liver cancer risk, HCC (10 cohorts), or ICC (6 cohorts). SSB intake per 1-beverage/day increase was not associated with total liver cancer risk but was associated with a 10% increased risk of HCC (HR, 1.10; 95% CI, 1.03-1.18; 10 cohorts) and 15% increased risk of ICC (HR, 1.15; 95% CI, 1.00-1.32; 6 cohorts). Overall, this study found that increased SSB consumption was associated with increased risk of HCC and ICC, while ASB intake was not associated with liver cancer risk overall or by subtype. These findings do not strongly support previously suggested associations between ASB and liver cancer, specifically aspartame and HCC. However, these findings suggest that reducing the consumption of SSB may be beneficial in lowering the risk of liver cancer. Some strengths of this study include a large study sample consisting of cohorts in the US and Europe, with long follow-up, and the analysis of cohorts using harmonized data. Some limitations of this study include self-reported intakes of ASB and SSB from dietary assessments, which are prone to measurement error; measuring ASB and SSB intake at only 1 point, which may not capture changes in consumption over time; the presence of residual confounding, such as underlying liver disease; and the presence of heterogeneity between cohorts despite harmonizing data. Future studies in other populations should confirm study findings and address these limitations.

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.